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Rakotondrasoa A, Andrianonimiadana LM, Rahajandraibe S, Razafimahatratra S, Andrianaivoarimanana V, Rahelinirina S, Crucitti T, Brisse S, Jeannoda V, Rajerison M, Collard JM. Characterization of Klebsiella pneumoniae isolated from patients suspected of pulmonary or bubonic plague during the Madagascar epidemic in 2017. Sci Rep 2022; 12:6871. [PMID: 35477743 PMCID: PMC9046156 DOI: 10.1038/s41598-022-10799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/15/2022] [Indexed: 11/09/2022] Open
Abstract
Klebsiella pneumoniae can lead to a wide range of diseases including pneumonia, bloodstream and urinary tract infections. During a short period of a pulmonary plague epidemic in October 2017 in Madagascar, 12 K. pneumoniae isolates were identified in ten sputum and two buboes aspirate samples. These isolates were from 12 patients suspected of plague, without epidemiological relationships, but were negative for Yersinia pestis in culture. Data were collected from the plague national surveillance system. The isolates were characterized by antimicrobial susceptibility testing and whole-genome sequencing. Real-time PCR was performed to confirm the presence of K. pneumoniae DNA in buboes. All isolates were identified as K. pneumoniae sensu stricto. Five isolates were extended-spectrum β-lactamases producers; eleven different sequence types were identified. Five isolates belonged to known hypervirulent sequence types. Our results demonstrate community-acquired pneumonia caused by K. pneumoniae isolates in patients suspected of plague stressing the importance of bed-side differential diagnosis.
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Affiliation(s)
| | | | | | | | | | | | - Tania Crucitti
- Experimental Bacteriology Unit, Institut Pasteur Madagascar, Antananarivo, Madagascar
| | - Sylvain Brisse
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France
| | - Victor Jeannoda
- Mention Biodiversité Et Santé, Sciences Faculty, University of Antananarivo, Antananarivo, Madagascar
| | | | - Jean-Marc Collard
- Experimental Bacteriology Unit, Institut Pasteur Madagascar, Antananarivo, Madagascar.,Experimental Bacteriology Laboratory, Center for Microbes, Development and Health (CMDH), Institut Pasteur of Shanghai/Chinese Academy of Sciences, Shanghai, People's Republic of China
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2
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Ahmed HA, Ibrahim EHS, Abdelhaliem E, Elariny EYT. Biotyping, Virulotyping and Biofilm Formation Ability of ESBL-Klebsiella pneumoniae Isolates from Nosocomial Infections. J Appl Microbiol 2022; 132:4555-4568. [PMID: 35384170 DOI: 10.1111/jam.15563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/05/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the frequency, molecular characterization, virulence genes, resistance genes and antimicrobial profile of nosocomial extended spectrum beta lactamase producing Klebsiella species. A total of 22 (12.2%) K. pneumoniae strains were isolated from 180 clinical samples collected from hospitalized patients in Egypt. K. pneumoniae biotypes were B1 (72.8%), B3 (13.6%) and B4 (13.6%). The isolates were classified for the capsular serotypes, 86.4% (20/22) were of K1 serotype, while only two isolates (13.64%) were of K2 serotype. Hypermucoviscous K. pneumoniae isolates accounted for 68.2%. Biofilm formation ability of K. pneumoniae was determined by microtitre plate method. The majority of the isolates (40.9%) were moderate biofilm producers, while 27.3% were strong biofilm producers. All K. pneumoniae strains were positive for fimH and traT genes, while magA was identified in only 63.6% of the isolates. The antibiotic susceptibility profile of the isolates (n=22) was determined by the disc diffusion technique using 23 different antibiotics. Streptomycin and imipenem are the most effective antibiotics against 22 tested K. pneumoniae isolates with sensitivity rates of 63.64% and 54.54%, respectively. All tested K. pneumoniae isolates showed high resistance to amoxicillin∕clavulanate (100%), cefuroxime (100%) and ceftazidime (95.45%). Extended spectrum beta lactamases (ESBL) production and the presence of ESBL related genes were tested in the isolates. All the isolates tested positive for blaVIM, NDM1, and blaTEM, while only 81.8 percent tested positive for the blaSHV gene. Increasing antimicrobial resistance in K. pneumoniae causing nosocomial infections limits the use of antimicrobial agents for treatment. Furthermore, the spread of biofilm, multiple drug resistant and ESBL-producing K. pneumoniae isolates is a public threat for hospitalized patients.
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Affiliation(s)
- Heba A Ahmed
- Department of Zoonoses, Faculty of Veterinary Medicine, Zagazig University, Sharkia Governorate, Zagazig City, Egypt
| | - Eman H S Ibrahim
- Department of Microbiology, Faculty of Science, Zagazig University, Sharkia Governorate, Egypt
| | - Ekram Abdelhaliem
- Cytology and Molecular genetics, Faculty of Science,, Zagazig University, Sharkia Governorate, Egypt
| | - Eman Y T Elariny
- Department of Microbiology, Faculty of Science, Zagazig University, Sharkia Governorate, Egypt
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3
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Paudel S, John PP, Poorbaghi SL, Randis TM, Kulkarni R. Systematic Review of Literature Examining Bacterial Urinary Tract Infections in Diabetes. J Diabetes Res 2022; 2022:3588297. [PMID: 35620571 PMCID: PMC9130015 DOI: 10.1155/2022/3588297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
This systematic review addresses the central research question, "what is known from the published, peer-reviewed literature about the impact of diabetes on the risk of bacterial urinary tract infections (UTI)?" We examine the results from laboratory studies where researchers have successfully adapted mouse models of diabetes to study the pathophysiology of ascending UTI. These studies have identified molecular and cellular effectors shaping immune defenses against infection of the diabetic urinary tract. In addition, we present evidence from clinical studies that in addition to diabetes, female gender, increased age, and diabetes-associated hyperglycemia, glycosuria, and immune impairment are important risk factors which further increase the risk of UTI in diabetic individuals. Clinical studies also show that the uropathogenic genera causing UTI are largely similar between diabetic and nondiabetic individuals, although diabetes significantly increases risk of UTI by drug-resistant uropathogenic bacteria.
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Affiliation(s)
- Santosh Paudel
- Department of Biology, University of Louisiana at Lafayette, Lafayette, LA, USA 70504
| | - Preeti P. John
- Department of Biology, University of Louisiana at Lafayette, Lafayette, LA, USA 70504
| | | | - Tara M. Randis
- Department of Pediatrics, University of South Florida, Tampa, FL, USA 33620
| | - Ritwij Kulkarni
- Department of Biology, University of Louisiana at Lafayette, Lafayette, LA, USA 70504
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4
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Ding Z, Li Z, Tang M, Zeng Z, Song M, Yang K, Ding Y, Wang Z, Liu J. The molecular characteristics, clinical manifestations, 44 and risk factors of hypervirulent Klebsiella pneumoniae infections in a large teaching hospital in southwest China. Microb Pathog 2021; 162:105152. [PMID: 34742892 DOI: 10.1016/j.micpath.2021.105152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/06/2021] [Accepted: 08/17/2021] [Indexed: 01/23/2023]
Abstract
Hypervirulent Klebsiella pneumoniae (hvKp) has been globally disseminated recently, especially in Asia. The purpose of this study was to identify the molecular characteristics, clinical manifestations, and clinical risk factors of hvKp infections among patients in a large teaching hospital. A retrospective study was conducted in 123 patients infected with K. pneumoniae at the Affiliated Hospital of Southwest Medical University (Luzhou, China) from October 2016 to November 2018. An isolate that positive for both PCR amplification of aerobactin gene and Galleria mellonella infection model was defined as hvKp. Overall, 43.1% (53/123) of K. pneumoniae isolates were hvKp. String tests were performed on all isolates, and MLSTs of all hvKp were conducted. The K1 ST23 isolates were the dominant clone of hvKp (35.8%). Univariate analysis revealed the following risk factors for hvKp: hepatic abscess (OR = 41.818 [95% CI, 5.379-335.086]), bacteremia (OR = 19.94 [95% CI, 5.565-71.446]), metastatic spread (OR = 19.938 [95% CI, 6.344-62.654]), CRP (OR = 1.008 [95% CI, 1.001-1.015]), nitroimidazole treatment (OR = 7.907 [95% CI, 1.652-37.843]), diabetes (OR = 3.067 [95% CI, 1.38-6.817]), and admission to positive culture interval (OR = 3.636 [95% CI, 1.524-8.678]). Moreover, Multivariate analysis implicated hepatic abscess (OR = 74.332 [95% CI, 3.121-1769.588]), bacteremia (OR = 28.388 [95% CI, 3.039-264.200]), and metastatic spread (OR = 19.391 [95% CI, 3.633-103.498]) as independent risk factors for hvKp infections. Thirteen of twenty-one tested antibiotics were founded resistance to non-hvKp, which is significantly greater than hvKp. Importantly, the ESBL-hvKp and MDR-hvKp were responsible for 7.5% and 15.1% in the hvKp group, respectively.
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Affiliation(s)
- Zixuan Ding
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China
| | - Zhaoyinqian Li
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China
| | - Min Tang
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China
| | - Zhangrui Zeng
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China
| | - Min Song
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China
| | - Kui Yang
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China
| | - Yinhuan Ding
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China
| | - Zhibin Wang
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China
| | - Jinbo Liu
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, PR China.
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Sharaha U, Suleiman M, Abu-Aqil G, Riesenberg K, Lapidot I, Salman A, Huleihel M. Determination of Klebsiella pneumoniae Susceptibility to Antibiotics Using Infrared Microscopy. Anal Chem 2021; 93:13426-13433. [PMID: 34585907 DOI: 10.1021/acs.analchem.1c00734] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Klebsiella pneumoniae (K. pneumoniae) is one of the most aggressive multidrug-resistant bacteria associated with human infections, resulting in high mortality and morbidity. We obtained 1190 K. pneumoniae isolates from different patients with urinary tract infections. The isolates were measured to determine their susceptibility regarding nine specific antibiotics. This study's primary goal is to evaluate the potential of infrared spectroscopy in tandem with machine learning to assess the susceptibility of K. pneumoniae within approximately 20 min following the first culture. Our results confirm that it was possible to classify the isolates into sensitive and resistant with a success rate higher than 80% for the tested antibiotics. These results prove the promising potential of infrared spectroscopy as a powerful method for a K. pneumoniae susceptibility test.
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Affiliation(s)
- Uraib Sharaha
- Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Manal Suleiman
- Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - George Abu-Aqil
- Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | | | - Itshak Lapidot
- Department of Electrical and Electronics Engineering, ACLP-Afeka Center for Language Processing, Afeka Tel-Aviv Academic College of Engineering, Tel-Aviv 69107, Israel
| | - Ahmad Salman
- Department of Physics, SCE-Shamoon College of Engineering, Beer-Sheva 84100, Israel
| | - Mahmoud Huleihel
- Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
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Pacheco T, Gomes AÉI, Siqueira NMG, Assoni L, Darrieux M, Venter H, Ferraz LFC. SdiA, a Quorum-Sensing Regulator, Suppresses Fimbriae Expression, Biofilm Formation, and Quorum-Sensing Signaling Molecules Production in Klebsiella pneumoniae. Front Microbiol 2021; 12:597735. [PMID: 34234747 PMCID: PMC8255378 DOI: 10.3389/fmicb.2021.597735] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
Klebsiella pneumoniae is a Gram-negative pathogen that has become a worldwide concern due to the emergence of multidrug-resistant isolates responsible for various invasive infectious diseases. Biofilm formation constitutes a major virulence factor for K. pneumoniae and relies on the expression of fimbrial adhesins and aggregation of bacterial cells on biotic or abiotic surfaces in a coordinated manner. During biofilm aggregation, bacterial cells communicate with each other through inter- or intra-species interactions mediated by signallng molecules, called autoinducers, in a mechanism known as quorum sensing (QS). In most Gram-negative bacteria, intra-species communication typically involves the LuxI/LuxR system: LuxI synthase produces N-acyl homoserine lactones (AHLs) as autoinducers and the LuxR transcription factor is their cognate receptor. However, K. pneumoniae does not produce AHL but encodes SdiA, an orphan LuxR-type receptor that responds to exogenous AHL molecules produced by other bacterial species. While SdiA regulates several cellular processes and the expression of virulence factors in many pathogens, the role of this regulator in K. pneumoniae remains unknown. In this study, we describe the characterization of sdiA mutant strain of K. pneumoniae. The sdiA mutant strain has increased biofilm formation, which correlates with the increased expression of type 1 fimbriae, thus revealing a repressive role of SdiA in fimbriae expression and bacterial cell adherence and aggregation. On the other hand, SdiA acts as a transcriptional activator of cell division machinery assembly in the septum, since cells lacking SdiA regulator exhibited a filamentary shape rather than the typical rod shape. We also show that K. pneumoniae cells lacking SdiA regulator present constant production of QS autoinducers at maximum levels, suggesting a putative role for SdiA in the regulation of AI-2 production. Taken together, our results demonstrate that SdiA regulates cell division and the expression of virulence factors such as fimbriae expression, biofilm formation, and production of QS autoinducers in K. pneumoniae.
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Affiliation(s)
- Thaisy Pacheco
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Ana Érika Inácio Gomes
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | | | - Lucas Assoni
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Michelle Darrieux
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Henrietta Venter
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Lúcio Fábio Caldas Ferraz
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
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Taraghian A, Nasr Esfahani B, Moghim S, Fazeli H. Characterization of Hypervirulent Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Among Urinary Tract Infections: The First Report from Iran. Infect Drug Resist 2020; 13:3103-3111. [PMID: 32982325 PMCID: PMC7489934 DOI: 10.2147/idr.s264440] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction This study was conducted to identify the hypermucoviscosity, iron acquisition, and capsule serotypes of K. pneumoniae strains isolated from urinary tract infections among community-acquired patients (CA) and assess the frequency of plasmid-mediated quinolone resistance (PMQR) and extended-spectrum beta-lactamases (ESBL) genes between classic and hypervirulent strains. Materials and Methods A total of 105 K. pneumoniae were isolated from CA-UTI. Demographic data related to the underlying diseases and clinical manifestations were further collected. Antibiotic resistance pattern and molecular characterization were compared among ESBL-positive, ESBL-negative, hypervirulent, and classic isolates. Results The results revealed that 52.4% of the isolates were confirmed as ESBL producers and 11 (10.5%) were considered as hypervirulent K. pneumoniae (hvKp). Ciprofloxacin and nalidixic acid were the most inactive antibiotics with resistance rates of 68.6% and 64.8%, respectively. Molecular characterization revealed that 7.6% of all the isolates carried k1 and 66.6% carried K2 genes. The most frequent ESBL gene was blaSHV 63.8%, followed by blaTEM 59.0%, and blaCTX-M 58.1%. ESBL genes were significantly more in hvKp than in cKp. Moreover, 61 (84.7%), 47 (65.2%), and 16 (22.2%) of isolates harbored qnrB, qnrS, and qnrA. ESBL genes were detected in all hvKps, and blaSHV was observed in 90.9% of hvKp (P value= 0.048, 95%). Discussion This study reported the high frequency of antimicrobial and multidrug resistance among hvKp isolates. Coexistence of PMQR and ESBL genes in hvkp indicates the necessity to enhance the clinical knowledge and management of hvKp infections.
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Affiliation(s)
- Azadeh Taraghian
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Nasr Esfahani
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharareh Moghim
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Fazeli
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Ali MH, Anwar S, Toma NJ, Rafid I, Hasan MK, Foysal MJ. Molecular Detection and PCR-RFLP Analysis of Mucoviscosity-Associated Gene A (magA) in Clinical Isolates of Multidrug-Resistant Klebsiella pneumoniae in Bangladesh. Open Microbiol J 2020. [DOI: 10.2174/1874285802014010196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective:
The mucoviscosity associated gene A (magA) in the hypermucoviscous variants of K. pneumoniae is reported to be associated with invasive infections and considered a virulence factor. We sought to analyze the magA genes in K. pneumoniae isolates in the clinical specimen collected from Bangladesh.
Methods:
We established a multicenter cohort of patients with Klebsiella infection hospitalized at 05 different hospitals between September 2016 and April 2017. We collected 313 K. pneumoniae isolates from patients who consented to participate in the study. The isolates were evaluated for harboring the magA genes using a single-tube multiplexed polymerase chain reaction. The magA genes were analyzed by PCR-RFLP technique using two enzymes, namely PciI and SmaI. Antibiogram assay using 12 commercially available antibiotic discs was performed on all the isolates.
Results:
The presence of K. pneumoniae specific gene (ureD) was confirmed in all the isolates. The percentage of isolates harboring the magA gene was 7.34%(23 isolates), the majority of which was collected from the patients admitted in intensive care units (16 isolates, 69.6%), and infectious diseases wards (5 isolates, 21.7%). PCR-RFLP analysis revealed that for 7 out of 23 isolates, where Sma1 could not cleave the magA gene. All the isolates showed resistance to ampicillin, carbenicillin cefradine, chloramphenicol, erythromycin, kanamycin, and sulphamethoxazole, though the extent was varying. However, imipenem showed 100% sensitivity to all the tested isolates.
Conclusion:
This study demonstrates the presence of the magA gene in multidrug-resistant clinical isolates of K. pneumoniae collected from Bangladesh.
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Zhong XS, Li YZ, Ge J, Xiao G, Mo Y, Wen YQ, Liu JP, Xiong YQ, Qiu M, Huo ST, Cheng MJ, Chen Q. Comparisons of microbiological characteristics and antibiotic resistance of Klebsiella pneumoniae isolates from urban rodents, shrews, and healthy people. BMC Microbiol 2020; 20:12. [PMID: 31937244 PMCID: PMC6961239 DOI: 10.1186/s12866-020-1702-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background The comparisons of molecular characterization and antibiotic resistance of Klebsiella pneumoniae (KP) isolates from humans and other animal hosts are not well studied. Our goal was to compare the molecular epidemiology of KP strains that were isolated from urban rodents, shrews, and healthy people. Results K. pneumoniae (KP) isolates were isolated from fecal samples of rodents, shrews and healthy adults in 2015 in southern China. In total, 465 fecal samples were collected, of which 85 from rodents, 105 from shrews, and 275 from healthy adults. Antimicrobial susceptibility and production of extended-spectrum β-lactamases (ESBL) of the isolates were tested. PCR-based methods were used to detect specific genes, including ESBL genes (blaTEM, blaSHV, and blaCTX-M) in ESBL-producing isolates, capsular serotypes (K1, K2, K5, K20, K54, and K57) in hypervirulent KPs (hvKPs), and virulence genes (magA, wcaG, rmpA, uge, kfu, and aerobactin) in hvKP isolates. Multilocus sequence type (MLST) and pulsed-field gel electrophoresis (PFGE) were performed to exclude the homology of these isolates. The carriage rate of KP in urban rodents and shrews (78.42%) was higher than that in healthy adults (66.18%) (χ2 = 8.206, P = 0.004). The prevalence rates of ESBL-producing isolates among rodents, shrews, and humans were 7.94, 12.79, and 17.03%, respectively. The positive rates of CTX-M, TEM and SHV types in ESBL-producing isolates were 29.79, 27.66, and 17.02%, respectively. Serotype K1, K5, K20, and K57 were detected in both small mammals and humans. PFGE typing revealed thirty-six clusters. PFGE cluster A was clustered by samples of shrews and healthy adult, with a similarity of 88.4%. MLST typing revealed thirty-eight types. ST23 and ST35 were detected in samples of shrews and healthy adults. ST37 was detected in samples of 2 rodents and a healthy adult. Conclusions Overlapping serotypes of hvKP were observed in both the animals and humans. The same PFGE or MLST types were also found in isolates derived humans, rodents and shrews. Therefore, urban rodents and shrews might play a certain role in the transmission of drug-resistant and hypervirulent KP.
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Affiliation(s)
- Xue-Shan Zhong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yong-Zhi Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Jing Ge
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Gang Xiao
- Department of clinical Laboratory, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Yun Mo
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yu-Qi Wen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Jing-Ping Liu
- Department of clinical Laboratory, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Yi-Quan Xiong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Min Qiu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Shu-Ting Huo
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Ming-Ji Cheng
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
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Patro LPP, Rathinavelan T. Targeting the Sugary Armor of Klebsiella Species. Front Cell Infect Microbiol 2019; 9:367. [PMID: 31781512 PMCID: PMC6856556 DOI: 10.3389/fcimb.2019.00367] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022] Open
Abstract
The emergence of multidrug-resistant strains of Gram-negative Klebsiella species is an urgent global threat. The World Health Organization has listed Klebsiella pneumoniae as one of the global priority pathogens in critical need of next-generation antibiotics. Compared to other Gram-negative pathogens, K. pneumoniae accumulates a greater diversity of antimicrobial-resistant genes at a higher frequency. The evolution of a hypervirulent phenotype of K. pneumoniae is yet another concern. It has a broad ecological distribution affecting humans, agricultural animals, plants, and aquatic animals. Extracellular polysaccharides of Klebsiella, such as lipopolysaccharides, capsular polysaccharides, and exopolysaccharides, play crucial roles in conferring resistance against the host immune response, as well as in colonization, surface adhesion, and for protection against antibiotics and bacteriophages. These extracellular polysaccharides are major virulent determinants and are highly divergent with respect to their antigenic properties. Wzx/Wzy-, ABC-, and synthase-dependent proteinaceous nano-machineries are involved in the biosynthesis, transport, and cell surface expression of these sugar molecules. Although the proteins involved in the biosynthesis and surface expression of these sugar molecules represent potential drug targets, variation in the amino acid sequences of some of these proteins, in combination with diversity in their sugar composition, poses a major challenge to the design of a universal drug for Klebsiella infections. This review discusses the challenges in universal Klebsiella vaccine and drug development from the perspective of antigen sugar compositions and the proteins involved in extracellular antigen transport.
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Zhao Y, Zhang X, Torres VVL, Liu H, Rocker A, Zhang Y, Wang J, Chen L, Bi W, Lin J, Strugnell RA, Zhang S, Lithgow T, Zhou T, Cao J. An Outbreak of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Wenzhou, China. Front Public Health 2019; 7:229. [PMID: 31552210 PMCID: PMC6736603 DOI: 10.3389/fpubh.2019.00229] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/30/2019] [Indexed: 12/13/2022] Open
Abstract
Carbapenem-resistant, hypervirulent Klebsiella pneumoniae (CR-hvKP) has recently emerged as a significant threat to public health. In this study, 29 K. pneumoniae isolates were isolated from eight patients admitted to the intensive care unit (ICU) of a comprehensive teaching hospital located in China from March 2017 to January 2018. Clinical information of patients was the basis for the further analyses of the isolates including antimicrobial susceptibility tests, identification of antibiotic resistance and virulence gene determinants, multilocus sequence typing (MLST), XbaI-macrorestriction by pulsed-field gel electrophoresis (PFGE). Selected isolates representing distinct resistance profiles and virulence phenotypes were screened for hypervirulence in a Galleria mellonella larvae infection model. In the course of the outbreak, the overall mortality rate of patients was 100% (n = 8) attributed to complications arising from CR-hvKP infections. All isolates except one (28/29, 96.6%) were resistant to multiple antimicrobial agents, and harbored diverse resistance determinants that included the globally prevalent carbapenemase blaKPC−2. Most isolates had hypervirulent genotypes being positive for 19 virulence-associated genes, including iutA (25/29, 86.2%), rmpA (27/29, 93.1%), ybtA (27/29, 93.1%), entB (29/29, 100%), fimH (29/29, 100%), and mrkD (29/29, 100%). MLST revealed ST11 for the majority of isolates (26/29, 89,7%). Infection assays demonstrated high mortality in the Galleria mellonella model with the highest LD50 values for three isolates (<105 CFU/mL) demonstrating the degree of hypervirulence of these CR-hvKP isolates, and is discussed relative to previous outbreaks of CR-hvKP.
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Affiliation(s)
- Yajie Zhao
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, China
| | - Xiucai Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Von Vergel L Torres
- Infection and Immunity Program, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Haiyang Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Andrea Rocker
- Infection and Immunity Program, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Yizhi Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiawei Wang
- Infection and Immunity Program, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Lijiang Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenzi Bi
- School of Medicine, The Fourth Affiliated Hospital of Zhejiang University, Jinhua, China
| | - Jie Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Richard A Strugnell
- Department of Microbiology and Immunology, The Peter Doherty Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Siqin Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Trevor Lithgow
- Infection and Immunity Program, Department of Microbiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianming Cao
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, China
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12
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Caneiras C, Lito L, Melo-Cristino J, Duarte A. Community- and Hospital-Acquired Klebsiella pneumoniae Urinary Tract Infections in Portugal: Virulence and Antibiotic Resistance. Microorganisms 2019; 7:microorganisms7050138. [PMID: 31100810 PMCID: PMC6560439 DOI: 10.3390/microorganisms7050138] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/15/2019] [Indexed: 11/23/2022] Open
Abstract
Klebsiella pneumoniae is a clinically relevant pathogen and a frequent cause of hospital-acquired (HA) and community-acquired (CA) urinary tract infections (UTI). The increased resistance of this pathogen is leading to limited therapeutic options. To investigate the epidemiology, virulence, and antibiotic resistance profile of K. pneumoniae in urinary tract infections, we conducted a multicenter retrospective study for a total of 81 isolates (50 CA-UTI and 31 HA-UTI) in Portugal. The detection and characterization of resistance and virulence determinants were performed by molecular methods (PCR, PCR-based replicon typing, and multilocus sequence typing (MLST)). Out of 50 CA-UTI isolates, six (12.0%) carried β-lactamase enzymes, namely blaTEM-156 (n = 2), blaTEM-24 (n = 1), blaSHV-11 (n = 1), blaSHV-33 (n = 1), and blaCTX-M-15 (n = 1). All HA-UTI were extended-spectrum β-lactamase (ESBL) producers and had a multidrug resistant profile as compared to the CA-UTI isolates, which were mainly resistant to ciprofloxacin, levofloxacin, tigecycline, and fosfomycin. In conclusion, in contrast to community-acquired isolates, there is an overlap between virulence and multidrug resistance for hospital-acquired UTI K. pneumoniae pathogens. The study is the first to report different virulence characteristics for hospital and community K. pneumoniae pathogens, despite the production of β-lactamase and even with the presence of CTX-M-15 ESBL, a successful international ST15 clone, which were identified in both settings. This highlights that a focus on genomic surveillance should remain a priority in the hospital environment.
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Affiliation(s)
- Cátia Caneiras
- Microbiology and Immunology Department, Interdisciplinary Research Centre Egas Moniz (CiiEM), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisboa, Portugal.
- Institute of Environmental Health (ISAMB), Faculty of Medicine, Universidade de Lisboa, 1649-028 Lisboa, Portugal.
| | - Luis Lito
- Laboratory of Microbiology, Centro Hospitalar Lisboa Norte, 1649-035 Lisboa, Portugal.
| | - José Melo-Cristino
- Laboratory of Microbiology, Centro Hospitalar Lisboa Norte, 1649-035 Lisboa, Portugal.
- Institute of Microbiology, Institute of Molecular Medicine, Faculty of Medicine, Universidade de Lisboa,1649-028 Lisboa, Portugal.
| | - Aida Duarte
- Microbiology and Immunology Department, Interdisciplinary Research Centre Egas Moniz (CiiEM), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisboa, Portugal.
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13
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Ranjbar R, Fatahian Kelishadrokhi A, Chehelgerdi M. Molecular characterization, serotypes and phenotypic and genotypic evaluation of antibiotic resistance of the Klebsiella pneumoniae strains isolated from different types of hospital-acquired infections. Infect Drug Resist 2019; 12:603-611. [PMID: 31114256 PMCID: PMC6489651 DOI: 10.2147/idr.s199639] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: Virulent and resistant Klebsiella pneumoniae strains are considered as one of the most significant causes of hospital-acquired infections. The present investigation was done to study the distribution of virulence factors, capsule serotypes and phenotypic and genotypic evaluation of antibiotic resistance of the K. pneumoniae strains isolated from hospital-acquired infections. Patients Materials and methods: Two hundred and sixty different types of hospital-acquired infections were collected and cultured. Antibiotic resistance pattern of K. pneumoniae isolates and their molecular characterization were studied using disk diffusion and PCR, respectively. Results: One hundred and fifty out of 260 (44.22%) hospital-acquired infections harbored K. pneumoniae. Urine samples (63.75%) had the highest prevalence of K. pneumoniae, while wound (33.33%) had the lowest. K. pneumoniae strains harbored the highest prevalence of resistance against ampicillin (100%), cefuroxime (100%), amoxicillin/clavulanic acid (95.65%) and ceftazidime (95.52%). FimH-1 (93.04%), traT (92.17%), mrkD (84.34%), and entB (80.86%) were the most commonly detected virulence genes. AcrAB (96.52%) and tolC (85.21%) were the most commonly detected antibiotic resistance genes. Prevalence of ompK35 and ompK36 virulence genes were 75.65% and 79.13%, respectively. Prevalence of K1 and K2-positive serotypes were 27.82% and 6.96%, respectively. Conclusions: High prevalence of resistance against several types of antibiotics and simultaneous presence of some virulence factors and multi-drug resistance genes pose an important public health issue.
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Affiliation(s)
- Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Chehelgerdi
- Biotechnology Research Center, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
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14
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Wijayabahu AT, Waugh SG, Ukhanova M, Mai V. Dietary raisin intake has limited effect on gut microbiota composition in adult volunteers. Nutr J 2019; 18:14. [PMID: 30845997 PMCID: PMC6404294 DOI: 10.1186/s12937-019-0439-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/22/2019] [Indexed: 01/01/2023] Open
Abstract
Background Dried fruits, such as raisins, contain phytochemicals and dietary fibers that contribute to maintaining health, potentially at least partially through modification in gut microbiota composition and activities. However, the effects of raisin consumption on gut microbiota have not previously been thoroughly investigated in humans. Therefore, the objective of this study was to determine how adding three servings of sun dried raisin/day to the diet of healthy volunteers affects gut microbiota composition. Methods A 14-day exploratory feeding study was conducted with thirteen healthy individuals between the ages of 18 and 59 years. Participants consumed three servings (28.3 g each) of sun dried raisins daily. Fecal samples were collected prior to raisin consumption (baseline) and after the addition of raisins to the diet (on days 7 and 14). To determine the effects of raisin intake, fecal microbiota composition before and after raisin consumption was characterized for each participant by 16S rRNA gene sequencing. Results Overall microbiota diversity was not significantly affected by adding raisins to the diet. However, upon addition of raisins to the diet specific OTUs matching Faecalibacterium prausnitzii, Bacteroidetes sp. and Ruminococcus sp. increased in prevalence while OTUs closest to Klebsiella sp., Prevotella sp. and Bifidobacterium spp. decreased. Conclusion Our findings suggest that adding raisins to the diet can affect the prevalence of specific bacterial taxa. Potential health benefits of the observed microbiota changes should be determined in future studies in populations for which specific health outcomes can be targeted. Trial registration http://www.clinicaltrials.gov; Identifier: NCT02713165. Electronic supplementary material The online version of this article (10.1186/s12937-019-0439-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akemi T Wijayabahu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, USA.,Emerging Pathogen Institute, University of Florida, Gainesville, USA
| | - Sheldon G Waugh
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, USA.,Emerging Pathogen Institute, University of Florida, Gainesville, USA
| | - Maria Ukhanova
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, USA.,Emerging Pathogen Institute, University of Florida, Gainesville, USA
| | - Volker Mai
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, USA. .,Emerging Pathogen Institute, University of Florida, Gainesville, USA. .,Present address: Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, Emerging Pathogen Institute, University of Florida, 2055 Mowry Road, Room 373, Gainesville, Florida, 32610-0009, USA.
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15
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Contamination of chicken meat with extended-spectrum beta-lactamase producing- Klebsiella pneumoniae and Escherichia coli during scalding and defeathering of broiler carcasses. Food Microbiol 2019; 77:185-191. [DOI: 10.1016/j.fm.2018.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 01/04/2023]
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16
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Liu C, Guo J. Hypervirulent Klebsiella pneumoniae (hypermucoviscous and aerobactin positive) infection over 6 years in the elderly in China: antimicrobial resistance patterns, molecular epidemiology and risk factor. Ann Clin Microbiol Antimicrob 2019; 18:4. [PMID: 30665418 PMCID: PMC6341648 DOI: 10.1186/s12941-018-0302-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/31/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The definition of hypervirulent Klebsiella pneumoniae (hvKp), traditionally regarded as hypermucoviscosity, is controversial. However, data based on both phenotype (hypermucoviscous) and genetic (aerobactin) criteria are limited. METHODS A retrospective study was conducted in 175 geriatric patients between January 2008 and January 2014. The clinical and molecular data, including antimicrobial susceptibility testing, extended-spectrum-β-lactamase (ESBL) production, virulence gene, and multilocus sequence typing of the hvKp-group (hypermucoviscosity and aerobactin positive) were compared with those of classic K. pneumoniae (cKp) isolates. RESULTS Of 175 Kp isolates, 45.7% were hvKp. In pathogenicity, K1, K2, magA, rmpA, and rmpA2 genes were strongly associated with hvKp (P < 0.01). In the hvKp group, invasive infections (P < 0.000), liver abscess (P = 0.008), abdominal infection (P = 0.002) and septic shock (P = 0.035) are significantly higher than cKp group. Patients with better nutritional status were frequently infected with hvKp. However, host inflammatory reaction is most severe in hvKp group. Patients with diabetes (odds ratio [OR] = 2.548) and digestive diseases (OR = 2.196) are more likely to be infected with hvKp. Importantly, the detection of hvKp isolates increased from January 2008 to January 2010, January 2010 to January 2012, and January 2010 to January 2014 (12, 30, and 48 isolates, respectively). Overall, 16.3% of hvKp isolates produced ESBLs and 20.0% were MDR-hvKp. Multivariate analysis implied that infection occurred in the ICU (OR = 5.826) and patients with indwelling stomach tubes (OR = 6.461) are independent risk factors for ESBL-hvKp infection. CONCLUSIONS HvKp, especially ESBL-hvKp and MDR-hvKp, is emerging in the elderly. It is essential to enhance clinical awareness and management of hvKp infections.
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Affiliation(s)
- Chao Liu
- Department of Respiratory Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Guo
- Department of Respiratory Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China. .,Department of Geriatric Respiratory Medicine, Chinese PLA General Hospital, Beijing, China.
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17
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Liu C, Shi J, Guo J. High prevalence of hypervirulent Klebsiella pneumoniae infection in the genetic background of elderly patients in two teaching hospitals in China. Infect Drug Resist 2018; 11:1031-1041. [PMID: 30104891 PMCID: PMC6074765 DOI: 10.2147/idr.s161075] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose Aerobactin is a critical factor for hypervirulent Klebsiella pneumoniae (hvKp) in genetic backgrounds, but data based on the genotype for the elderly is limited. Materials and methods A retrospective study was conducted on elderly patients from June 2008 to July 2017 in 2 teaching hospitals. The clinical and microbiological data, including antimicrobial susceptibility testing, string test, extended-spectrum β-lactamase (ESBL) production, virulence gene, and multilocus sequence typing, of the hvKp group defined as aerobactin positive were compared with those of classic K. pneumoniae isolates. Results A total of 45.7% of 202 K. pneumoniae isolates were hvKp.ST23, which were predominant in 2 hospitals, but they were not highly associated with hvKp in different hospitals. Hypermucoviscosity, K1, K2, magA, and rmpA/A2 genes were highly related to hvKp (P=0.000). With regard to the host, invasive infections (P=0.000), liver abscess (P=0.000), abdominal infection (P=0.000), pneumonia (P=0.037), and septic shock (P=0.045) were significantly higher in the elderly with hvKp. In the hvKp group, patients with better nutritional status were associated with a more severe sequential organ failure assessment score and a more serious inflammation reaction. Patients with diabetes (odds ratio [OR]=2.566) are more likely to be infected with hvKp. Previous hvKp is associated with hypermucoviscosity (OR=15.249) are often paralleled with hvKp. Importantly, 26% of hvKp isolates produced ESBLs, and most of them showed a carbapenems-resistant (CR) phenotype. Multivariate analysis implied that patients with a history of surgery within the last 1 month (OR=15.999) is an independent risk factor for CR-hvKp infection. Conclusion The prevalence of hvKP is high in the elderly. ESBL-hvKp, especially CR-hvKp, is emerging, which is a sign that clinical awareness and infection monitoring needs to improve.
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Affiliation(s)
- Chao Liu
- Department of Respiratory Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Jiaojiao Shi
- Department of Respiratory Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Jun Guo
- Department of Respiratory Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China, .,Department of Geriatric Respiratory Medicine, Chinese PLA General Hospital, Beijing, China,
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18
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Ikeda M, Mizoguchi M, Oshida Y, Tatsuno K, Saito R, Okazaki M, Okugawa S, Moriya K. Clinical and microbiological characteristics and occurrence of Klebsiella pneumoniae infection in Japan. Int J Gen Med 2018; 11:293-299. [PMID: 30034248 PMCID: PMC6049057 DOI: 10.2147/ijgm.s166940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Klebsiella pneumoniae is a pathogen that causes pneumonia and urinary tract infection. Hypervirulent K. pneumoniae strains often show hypermucoviscosity, are of the K1 or K2 serotype, and harbor the rmpA and magA genes. However, the differences in the prevalence of K. pneumoniae with these hypervirulent characteristics between the infection and colonization status are not well understood. Therefore, in this study, we compared the clinical and microbiological characteristics of K. pneumoniae isolated from urine or sputum samples of cases of infection and colonization. Patients and methods This retrospective study was conducted at a tertiary care teaching hospital in Tokyo, Japan. Patients whose sputum or urine tested positive for the presence of K. pneumoniae isolates were randomly included in the study. Clinical and microbiological data were collected from medical records. Results Of the 130 cases investigated, 68 and 62 cases showed the presence of K. pneumoniae in the sputum and urine, respectively. There were 49 infection cases, including 21 in the sputum group and 28 in the urine group. The infections were not accompanied by liver abscess. Of the 130 K. pneumoniae isolates, 25 (19.2%) showed capsular serotype K1 or K2, whereas 33 (25.4%) showed hypermucoviscosity. The prevalence of virulence genes magA, allS, rmpA, mrkD, uge, kfu-BC, and wabG was 10% (all in K1), 13.1%, 16.9%, 85.4%, 79.2%, 36.9%, and 91.5%, respectively. In both the sputum and urine groups, there was no difference in the characteristics of patients with infection and those with colonization. Analysis of microbiological characteristics revealed that only rmpA was significantly more frequent in the infection cases than in the colonization/asymptomatic cases in both the sputum and urine groups. Conclusion The rmpA-positive K. pneumoniae isolates were dominant in the infection cases compared with those in the colonization/asymptomatic cases, suggesting that rmpA may play a crucial role in the development of urinary tract infection and pneumonia.
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Affiliation(s)
- Mahoko Ikeda
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan.,Department of Infectious Diseases, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan,
| | - Miyuki Mizoguchi
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yukie Oshida
- Division of Infectious Diseases, Shizuoka Cancer Center, Simonagakubo, Nagaizumi-chou, Suntou-gun, Shizuoka, Japan
| | - Keita Tatsuno
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryoichi Saito
- Department of Microbiology and Immunity, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Mitsuhiro Okazaki
- Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Kamata, Ota-ku, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan,
| | - Kyoji Moriya
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan.,Department of Infectious Diseases, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan,
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19
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Zhang L, Tian Y, Yang J, Li J, Tang H, Wang Y. Colon Ascendens Stent Peritonitis (CASP) Induces Excessive Inflammation and Systemic Metabolic Dysfunction in a Septic Rat Model. J Proteome Res 2017; 17:680-688. [PMID: 29205045 DOI: 10.1021/acs.jproteome.7b00730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The colon ascendens stent peritonitis (CASP) surgery induces a leakage of gut contents, causing polymicrobial sepsis related to post-operative multiple organ failure and death in surgical patient. To evaluate the effects of CASP on multiple organs, we analyzed the systemic metabolic consequences in liver, kidney, lung, and heart of rats after CASP by employing a combination of metabolomics, clinical chemistry, and biological assays. We found that CASP surgery after 18 h resulted in striking elevations of lipid, amino acids, acetate, choline, PC, and GPC in rat liver together with significant depletion of glucose and glycogen. Marked elevations of organic acids including lactate, acetate, and creatine and amino acids accompanied by decline of glucose, betaine, TMAO, choline metabolites (PC and GPC) nucleotides, and a range of organic osmolytes such as myo-inositol are observed in the kidney of 18 h post-operative rat. Furthermore, 18 h post-operative rats exhibited accumulations of lipid, amino acids, and depletions of taurine, myo-inositol, choline, PC, and GPC and some nucleotides including uridine, inosine, and adenosine in the lung. In addition, significant elevations of some amino acids, uracil, betaine, and choline metabolites, together with depletion of inosine-5'-monophosphate, were only observed in the heart of 18 h post-operative rats. These results provide new insights into pathological consequences of CASP surgery, which are important for timely prognosis of sepsis.
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Affiliation(s)
- Limin Zhang
- CAS Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Centre for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences (CAS) , Wuhan 430071, China
| | - Yuan Tian
- CAS Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Centre for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences (CAS) , Wuhan 430071, China
| | - Jianfen Yang
- Research Institute of General Surgery, General Hospital of Nanjing Military Region , Nanjing, Jiangsu 210002, China
| | - Jieshou Li
- Research Institute of General Surgery, General Hospital of Nanjing Military Region , Nanjing, Jiangsu 210002, China
| | - Huiru Tang
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Centre for Genetics and Development, Shanghai International Centre for Molecular Phenomics, Zhongshan Hospital, School of Life Sciences, Fudan University , Shanghai 200433, PR China
| | - Yulan Wang
- CAS Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Centre for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences (CAS) , Wuhan 430071, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University , Hangzhou 310058, PR China
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20
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Wasfi R, Elkhatib WF, Ashour HM. Molecular typing and virulence analysis of multidrug resistant Klebsiella pneumoniae clinical isolates recovered from Egyptian hospitals. Sci Rep 2016; 6:38929. [PMID: 28004732 PMCID: PMC5177892 DOI: 10.1038/srep38929] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/15/2016] [Indexed: 01/30/2023] Open
Abstract
Klebsiella pneumonia infection rates have increased dramatically. Molecular typing and virulence analysis are powerful tools that can shed light on Klebsiella pneumonia infections. Whereas 77.7% (28/36) of clinical isolates indicated multidrug resistant (MDR) patterns, 50% (18/36) indicated carpabenem resistance. Gene prevalence for the AcrAB efflux pump (82.14%) was more than that of the mdtK efflux pump (32.14%) in the MDR isolates. FimH-1 and mrkD genes were prevalent in wound and blood isolates. FimH-1 gene was prevalent in sputum while mrkD gene was prevalent in urine. Serum resistance associated with outer membrane protein coding gene (traT) was found in all blood isolates. IucC, entB, and Irp-1 were detected in 32.14%, 78.5% and 10.7% of MDR isolates, respectively. We used two Polymerase Chain Reaction (PCR) analyses: Enterobacterial Repetitive Intergenic Consensus (ERIC) and Random Amplified Polymorphic DNA (RAPD). ERIC-PCR revealed 21 and RAPD-PCR revealed 18 distinct patterns of isolates with similarity ≥80%. ERIC genotyping significantly correlated with resistance patterns and virulence determinants. RAPD genotyping significantly correlated with resistance patterns but not with virulence determinants. Both RAPD and ERIC genotyping methods had no correlation with the capsule types. These findings can help up better predict MDR Klebsiella pneumoniae outbreaks associated with specific genotyping patterns.
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Affiliation(s)
- Reham Wasfi
- Department of Microbiology & Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts, Giza, Egypt
| | - Walid F. Elkhatib
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
- Department of Pharmacy Practice, School of Pharmacy, Chapman University, Orange, California, USA
| | - Hossam M. Ashour
- Department of Biological Sciences, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, Florida, USA
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Complete Genome Sequence of Community-Acquired Klebsiella pneumoniae KP36, a Strain Isolated from a Patient with an Upper Urinary Tract Infection. GENOME ANNOUNCEMENTS 2016; 4:4/6/e01403-16. [PMID: 27979951 PMCID: PMC5159584 DOI: 10.1128/genomea.01403-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Here, we announce the complete genome sequence of Klebsiella pneumoniae KP36, a strain isolated from a patient with a severe community-acquired urinary tract infection. This genome provides insights into the pathogenesis of a pandemic K. pneumoniae strain from a community-acquired urinary tract infection.
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Distribution of virulence genes and genotyping of CTX-M-15-producing Klebsiella pneumoniae isolated from patients with community-acquired urinary tract infection (CA-UTI). Microb Pathog 2016; 100:244-249. [PMID: 27725280 DOI: 10.1016/j.micpath.2016.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/23/2016] [Accepted: 10/06/2016] [Indexed: 11/21/2022]
Abstract
Klebsiella pneumoniae is one of the most important agents of community-acquired urinary tract infection (CA-UTI). In addition to extended-spectrum β-lactamases (ESBLs), a number of virulence factors have been shown to play an important role in the pathogenesis of K. pneumoniae, including capsule, siderophores, and adhesins. Little is known about the genetic diversity and virulence content of the CTX-M-15-producing K. pneumoniae isolated from CA-UTI in Iran. A total of 152 K. pneumoniae isolates were collected from CA-UTI patients in Tehran from September 2015 through April 2016. Out of 152 isolates, 40 (26.3%) carried blaCTX-M-15. PCR was performed for detection of virulence genes in CTX-M-15-producing isolates. Furthermore, all of these isolates were subjected to multiple-locus variable-number of tandem repeat (VNTR) analysis (MLVA). Using MLVA method, 36 types were identified. CTX-M-15-producing K. pneumoniae isolates were grouped into 5 clonal complexes (CCs). Of these isolates, mrkD was the most prevalent virulence gene (95%), followed by kpn (60%), rmpA (37.5%), irp (35%), and magA (2.5%). No correlation between MLVA types or CCs and virulence genes or antibiotic resistance patterns was observed. Overall, it is thought that CTX-M-15-producing K. pneumoniae strains isolated from CA-UTI have arisen from different clones.
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Genetic analysis of capsular polysaccharide synthesis gene clusters in 79 capsular types of Klebsiella spp. Sci Rep 2015; 5:15573. [PMID: 26493302 PMCID: PMC4616057 DOI: 10.1038/srep15573] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 09/28/2015] [Indexed: 11/15/2022] Open
Abstract
A total of 79 capsular types have been reported in Klebsiella spp., whereas capsular polysaccharide synthesis (cps) regions were available in only 22 types. Due to the limitations of serotyping, complete repertoire of cps will be helpful for capsular genotyping. We therefore resolved the rest 57 cps and conducted comparative analysis. Clustering results of 1,515 predicted proteins from cps loci categorized proteins which share similarity into homology groups (HGs) revealing that 77 Wzy polymerases were classified into 56 HGs, which indicate the high specificity of wzy between different types. Accordingly, wzy-based capsular genotyping could differentiate capsule types except for those lacking wzy (K29 and K50), those sharing identical wzy (K22 vs. K37); and should be carefully applied in those exhibited high similarity (K12 vs. K41, K2 vs. K13, K74 vs. K80, K79 vs. KN1 and K30 vs. K69). Comparison of CPS structures in several capsular types that shared similarity in their gene contents implies possible functions of glycosyltransferases. Therefore, our results provide complete set of cps in various types of Klebsiella spp., which enable the understandings of relationship between genes and CPS structures and are useful for identification of documented or new capsular types.
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Maatallah M, Vading M, Kabir MH, Bakhrouf A, Kalin M, Nauclér P, Brisse S, Giske CG. Klebsiella variicola is a frequent cause of bloodstream infection in the stockholm area, and associated with higher mortality compared to K. pneumoniae. PLoS One 2014; 9:e113539. [PMID: 25426853 PMCID: PMC4245126 DOI: 10.1371/journal.pone.0113539] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/27/2014] [Indexed: 01/26/2023] Open
Abstract
Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10–8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with isolates belonging to K. variicola. The increased mortality could not be related to any known virulence factors, including virulent capsular types or mucoid phenotype.
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Affiliation(s)
- Makaoui Maatallah
- Laboratoire d’Analyse, Traitement et Valorisation des Polluants de l’Environnement et des Produits, Faculté de Pharmacie, University of Monastir, Montasir, Tunisia
| | - Malin Vading
- Clinical Microbiology, MTC – Karolinska Institutet, Karolinska University, Hospital Solna, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Muhammad Humaun Kabir
- Clinical Microbiology, MTC – Karolinska Institutet, Karolinska University, Hospital Solna, Stockholm, Sweden
| | - Amina Bakhrouf
- Laboratoire d’Analyse, Traitement et Valorisation des Polluants de l’Environnement et des Produits, Faculté de Pharmacie, University of Monastir, Montasir, Tunisia
| | - Mats Kalin
- Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Sylvain Brisse
- Institut Pasteur, Microbial Evolutionary Genomics, Paris, France
- CNRS, Paris, France
| | - Christian G. Giske
- Clinical Microbiology, MTC – Karolinska Institutet, Karolinska University, Hospital Solna, Stockholm, Sweden
- * E-mail:
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Hyun JI, Kim YJ, Jeon YH, Kim SI, Park YJ, Kang MW, Kim W, Jang JH. A Case of Ventriculitis Associated with Renal Abscess Caused by Serotype K1 Klebsiella pneumoniae. Infect Chemother 2014; 46:120-4. [PMID: 25024876 PMCID: PMC4091369 DOI: 10.3947/ic.2014.46.2.120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022] Open
Abstract
Recently, serotype K1 Klebsiella pneumoniae has been a major agent of an invasive syndrome characterized by liver abscess and its metastatic infection. Extrahepatic infection and its characteristics in patients with renal abscess caused by K. pneumoniae are poorly understood, and few cases of central nervous system infection have been reported. This is a report of 80-year-old woman with uncontrolled type 2 diabetes mellitus with renal abscess caused by serotype K1 K. pneumoniae, complicated with ventriculitis despite of appropriate use of antibiotics. Physicians need to be aware of possibility of metastatic infection in patients with serotype K1 K. pneumoniae infection, if they develop neurologic symptom and focus of infection is still present.
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Affiliation(s)
- Ji In Hyun
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Youn Jeong Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yoon Hee Jeon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yeon Joon Park
- Department of Laboratory Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Moon Won Kang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Woohyeon Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hye Jang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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26
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Lin WH, Kao CY, Yang DC, Tseng CC, Wu AB, Teng CH, Wang MC, Wu JJ. Clinical and microbiological characteristics of Klebsiella pneumoniae from community-acquired recurrent urinary tract infections. Eur J Clin Microbiol Infect Dis 2014; 33:1533-9. [PMID: 24756209 DOI: 10.1007/s10096-014-2100-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
Understanding the pathogenesis of recurrent urinary tract infection (RUTI) and whether it is attributable to reinfection with a new strain or relapse with the primary infecting strain is of considerable importance. Because previous studies regarding community-acquired Klebsiella pneumoniae RUTI are inconclusive, we undertook this study to evaluate the characteristics of the host and the bacterial agent K. pneumoniae in RUTI. A prospective study was designed, using consecutive patients diagnosed with community-acquired K. pneumoniae-related UTI from January 2007 to December 2009. Of the total 468 consecutive episodes, we found 7 patients with RUTI. All the patients with RUTI were elderly (median, 74 years), with diabetes (100 %, 7 out of 7). Clinical K. pneumoniae isolates derived from the same patients with RUTI revealed identical genomic fingerprints, indicating that K. pneumoniae UTI relapsed despite appropriate antibiotic therapy. The antimicrobial resistance, growth curve and biofilm formation of the recurrent isolates did not change. K. pneumoniae strains causing RUTI had more adhesion and invasiveness than the colonization strains (p < 0.01). When we compared the recurrent strains with the community-acquired UTI strains, the prevalence of diabetes mellitus was significant (100 % vs 53.7 %, p = 0.03) in the RUTI group. Our data suggest that K. pneumoniae strains might be able to persist within the urinary tract despite appropriate antibiotic treatment, and the greater adhesion and invasiveness in the recurrent strains may play an important role in recurrent infections.
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Affiliation(s)
- W H Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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27
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Pan YJ, Lin TL, Chen YH, Hsu CR, Hsieh PF, Wu MC, Wang JT. Capsular types of Klebsiella pneumoniae revisited by wzc sequencing. PLoS One 2013; 8:e80670. [PMID: 24349011 PMCID: PMC3857182 DOI: 10.1371/journal.pone.0080670] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 10/05/2013] [Indexed: 01/03/2023] Open
Abstract
Capsule is an important virulence factor in bacteria. A total of 78 capsular types have been identified in Klebsiella pneumoniae. However, there are limitations in current typing methods. We report here the development of a new genotyping method based on amplification of the variable regions of the wzc gene. Fragments corresponding to the variable region of wzc were amplified and sequenced from 76 documented capsular types of reference or clinical strains. The remaining two capsular types (reference strains K15 and K50) lacked amplifiable wzc genes and were proven to be acapsular. Strains with the same capsular type exhibited ≧94% DNA sequence identity across the variable region (CD1-VR2-CD2) of wzc. Strains with distinct K types exhibited <80% DNA sequence identity across this region, with the exception of three pairs of strains: K22/K37, K9/K45, and K52/K79. Strains K22 and K37 shared identical capsular polysaccharide synthesis (cps) genes except for one gene with a difference at a single base which resulted in frameshift mutation. The wzc sequences of K9 and K45 exhibited high DNA sequence similarity but possessed different genes in their cps clusters. K52 and K79 exhibited 89% wzc DNA sequence identity but were readily distinguished from each other at the DNA level; in contrast, strains with the same capsular type as K52 exhibited 100% wzc sequence identity. A total of 29 strains from patients with bacteremia were typed by the wzc system. wzc DNA sequences confirmed the documented capsular type for twenty-eight of these clinical isolates; the remaining strain likely represents a new capsular type. Thus, the wzc genotyping system is a simple and useful method for capsular typing of K. pneumoniae.
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Affiliation(s)
- Yi-Jiun Pan
- Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Lung Lin
- Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hua Chen
- Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Ru Hsu
- Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Fang Hsieh
- Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Meng-Chuan Wu
- Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Town Wang
- Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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28
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Lin WH, Tseng CC, Wu AB, Yang DC, Cheng SW, Wang MC, Wu JJ. Clinical and microbiological characteristics of peritoneal dialysis-related peritonitis caused by Klebsiella pneumoniae in southern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 48:276-83. [PMID: 24291619 DOI: 10.1016/j.jmii.2013.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/12/2013] [Accepted: 07/25/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE(S) Gram-negative peritonitis is a frequent and serious complication of peritoneal dialysis (PD). No previous reports have focused on Klebsiella pneumoniae infection. The aim of this study was to investigate the host and bacterial factors associated with K. pneumoniae PD-related peritonitis. METHODS We retrospectively studied K. pneumoniae PD-peritonitis cases treated at a university hospital in southern Taiwan during 1990-2011, and analyzed the clinical features and outcomes and bacterial characteristics of serotypes, hypermucoviscosity (HV), and virulence-associated genes such as wabG, uge, and rmpA in K. pneumoniae PD-related peritonitis. Fifty-four isolates of K. pneumoniae-related community-acquired urinary tract infection (UTI) and 76 morphologically different nonpathogenic K. pneumoniae isolates from healthy adults were used as controls. RESULTS K. pneumoniae was the second most common monomicrobial pathogen causing Gram-negative PD-related peritonitis (n = 13, 2.7%), and the most common pathogen involved in polymicrobial peritonitis (16/43, 37.2%) and associated with high catheter removal rate (7/16, 43.8%). Compared with Escherichia coli peritonitis cases, patients with monomicrobial K. pneumoniae peritonitis also had insignificantly higher incidence of sepsis/bacteremia [n = 5 (38%), p = 0.11] and a higher mortality rate [n = 3 (23%), p = 0.36]. The prevalence of K1/K2 (n = 1, 7.7%) serotypes was low, but there was a higher prevalence of serotype K20 (n = 3, 23.1%) in K. pneumoniae isolates derived from monomicrobial PD-related peritonitis compared with control groups. HV phenotype (p < 0.001) and rmpA genotype (p = 0.007) were absent in the peritonitis group. CONCLUSION This is the first study focused on clinical and microbiological characteristics of K. pneumoniae PD-related peritonitis. K. pneumoniae was a common Gram-negative pathogen causing monomicrobial and polymicrobial PD-related peritonitis in southern Taiwan. The bacterial characteristics with low percentage of capsular serotype K1/K2, no significant HV, and absence of rmpA suggest a different pathogenesis in K. pneumoniae PD-related peritonitis compared with that in UTI and liver abscess.
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Affiliation(s)
- Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Chung Tseng
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - An-Bang Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Deng-Chi Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shian-Wen Cheng
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Cheng Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Jiunn-Jong Wu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan.
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29
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Li W, Sun G, Yu Y, Li N, Chen M, Jin R, Jiao Y, Wu H. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis 2013; 58:225-32. [PMID: 24099919 DOI: 10.1093/cid/cit675] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND New hypervirulent variants of Klebsiella pneumoniae (hvKP) are emerging globally, most of which exhibit antimicrobial susceptibility. METHODS A retrospective study was conducted in 88 patients with cultures positive for K. pneumoniae hospitalized in the Beijing You'an Hospital from April 2010 to June 2012. The clinical and molecular data of the hvKP isolates (defined as string test positive) were compared with those of the classic K. pneumoniae (cKP) isolates. RESULTS Overall, 33.0% (29/88) of K. pneumoniae isolates were hvKP. Univariate analysis revealed the following risk factors for hvKP: virulence gene rmpA (odds ratio [OR], 16.92 [95% confidence interval {CI}, 4.842-59.145]), capsule antigens K1 (OR, 3.355 [95% CI, 1.153-9.768]) and K2 (OR, 9.280 [95% CI, 0.987-87.250]), alcoholic hepatitis (OR, 7.435 [95% CI, 1.397-39.572]), liver abscess (OR, 9.068 [95% CI, 1.747-47.061]), metastatic infection (OR, 2.752 [95% CI, 1.100-6.886]), community-acquired infection (OR, 10.432 [95% CI, 3.623-30.033]), sputum isolation (OR, 0.312 [95% CI, .095-1.021]), and HIV infection (<0.001 [not applicable]). Multivariate analysis implicated rmpA (OR, 17.398 [95% CI, 4.224-71.668]) and community-acquired infection (OR, 6.844 [95% CI, 1.905-24.585]) as independent risk factors. The proportion of hvKP isolates increased from April to December 2010, January to September 2011, and October 2011 to June 2012 (to 25.5%, 26.7%, and 54.5%, respectively). Resistance to 14 of 19 tested antimicrobials was found to be significantly greater in cKP compared to hvKP. Importantly, resistance to all the tested antimicrobials, except carbapenems and amikacin, was observed in a proportion of hvKP strains, 17% (5/29) of which expressed extended-spectrum β-lactamase. Furthermore, antimicrobial resistance in hvKP strains increased over time. CONCLUSIONS HvKP strains are being isolated from patients in China with increasing frequency and constitute an increasing proportion of K. pneumoniae strains, indicating an increasing propensity for the acquisition of antimicrobial resistance.
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Affiliation(s)
- Wei Li
- Department of Infectious Diseases
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30
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Capsular serotypes and multilocus sequence types of bacteremic Klebsiella pneumoniae isolates associated with different types of infections. Eur J Clin Microbiol Infect Dis 2013; 33:365-9. [PMID: 24013597 DOI: 10.1007/s10096-013-1964-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
We investigated the epidemiology of different serotypes of Klebsiella pneumoniae isolates causing bacteremic liver abscess (LA) using multilocus sequence typing (MLST). MLST and molecular typing were performed for 41 K1 (19 LA), 37 K2 (5 LA), and 33 non-K1/K2 (6 LA) isolates that were derived from a previous one-year K. pneumoniae bacteremia cohort. Capsular serotypes and rmpA of these isolates were determined by polymerase chain reaction (PCR) methods. Among the 41 K1 isolates, 39 were ST23 and the remaining two isolates were ST23 single-locus variant. There were 11 STs among K2 isolates. ST65 was the most common (n = 10), followed by ST86, ST373, and ST375. Only ST65 (n = 3), ST373 (n = 1), and ST375 (n = 1) caused LA, and ST65 was a three-locus variant of ST23. For non-K1/K2 isolates, the ST types varied widely. ST218 (K57) was the most common type (n = 6, 18 %), and it was a single-locus variant of ST23 and caused two cases of LA. The existences of rmpA among serotypes varied (100 % for K1, 89 % for K2, and 55 % for non-K1/K2). For isolates causing LA, all of them were positive for rmpA. For non-K1/K2 isolates causing infections other than LA, the positivity of rmpA ranged from 0 % (biliary tree infection) to 67 % (pneumonia). In this one-year cohort, all K1 isolates were ST23 or its single-locus variants, but the composition of ST types among K2 isolates was quite variable. ST23 and its one- (ST1005 and ST218) and three-locus (ST65) variants comprised 80 % of isolates causing LA.
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31
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Suzuki K, Nakamura A, Enokiya T, Iwashita Y, Tomatsu E, Muraki Y, Kaneko T, Okuda M, Katayama N, Imai H. Septic arthritis subsequent to urosepsis caused by hypermucoviscous Klebsiella pneumoniae. Intern Med 2013; 52:1641-5. [PMID: 23857101 DOI: 10.2169/internalmedicine.52.0175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the first case of septic arthritis caused by rmpA-positive hypermucoviscous community-acquired K. pneumoniae that followed urosepsis in a 65-year-old Japanese woman. The patient responded well to drainage of the abscesses and treatment with cefazolin. Although this virulent phenotype of K. pneumoniae has been primarily reported in Hong Kong, we confirmed that 18/50 isolates obtained in our hospital over the past five years displayed the hypermucoviscous phenotype. Therefore, clinicians should consider the possibility of an increasing prevalence of rmpA-positive hypermucoviscous K. pneumoniae infection in Japan and be particularly vigilant for invasive clinical manifestations, even in patients with urinary tract infections.
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Affiliation(s)
- Kei Suzuki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Japan.
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32
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Dong F, Wang B, Zhang L, Tang H, Li J, Wang Y. Metabolic response to Klebsiella pneumoniae infection in an experimental rat model. PLoS One 2012; 7:e51060. [PMID: 23226457 PMCID: PMC3511377 DOI: 10.1371/journal.pone.0051060] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/29/2012] [Indexed: 01/04/2023] Open
Abstract
Bacteremia, the presence of viable bacteria in the blood stream, is often associated with several clinical conditions. Bacteremia can lead to multiple organ failure if managed incorrectly, which makes providing suitable nutritional support vital for reducing bacteremia-associated mortality. In order to provide such information, we investigated the metabolic consequences of a Klebsiella pneumoniae (K. pneumoniae) infection in vivo by employing a combination of (1)H nuclear magnetic resonance spectroscopy and multivariate data analysis. K. pneumoniae was intravenously infused in rats; urine and plasma samples were collected at different time intervals. We found that K. pneumoniae-induced bacteremia stimulated glycolysis and the tricarboxylic acid cycle and also promoted oxidation of fatty acids and creatine phosphate to facilitate the energy-demanding host response. In addition, K. pneumoniae bacteremia also induced anti-endotoxin, anti-inflammatory and anti-oxidization responses in the host. Furthermore, bacteremia could cause a disturbance in the gut microbiotal functions as suggested by alterations in a range of amines and bacteria-host co-metabolites. Our results suggest that supplementation with glucose and a high-fat and choline-rich diet could ameliorate the burdens associated with bacteremia. Our research provides underlying pathological processes of bacteremia and a better understanding of the clinical and biochemical manifestations of bacteremia.
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Affiliation(s)
- Fangcong Dong
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Centre for Magnetic Resonance, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, P. R. China
- Graduate School of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Bin Wang
- Research Institute of General Surgery, Jinling Hospital, Nanjing, Jiangsu, People’s Republic of China
| | - Lulu Zhang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Centre for Magnetic Resonance, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, P. R. China
- Graduate School of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Huiru Tang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Centre for Magnetic Resonance, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, P. R. China
| | - Jieshou Li
- Research Institute of General Surgery, Jinling Hospital, Nanjing, Jiangsu, People’s Republic of China
| | - Yulan Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Centre for Magnetic Resonance, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, P. R. China
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33
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Case of endogenous endophthalmitis caused by Klebsiella pneumoniae with magA and rmpA genes in an immunocompetent patient. J Infect Chemother 2012; 19:326-9. [PMID: 22992835 DOI: 10.1007/s10156-012-0468-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
Abstract
We report a case of endogenous endophthalmitis caused by Klebsiella pneumoniae in an immunocompetent patient. A 73-year-old man with acute epididymitis who had no history of diabetes mellitus developed endogenous endophthalmitis. The patient underwent anterior vitrectomy and intracapsular cataract extraction with intravitreal injections of both vancomycin and ceftazidime. After the surgery, he was treated with topical and intravenous antibiotics; however, the left eye perforated and was enucleated. Culture from vitreous biopsy specimens grew as K. pneumoniae, which was positive for both magA and rmpA. K. pneumoniae should be considered as a pathogen that can cause severe endogenous endophthalmitis in patients with urinary tract infection. The severity of the disease may be related to the virulence genes.
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Microbiological and clinical characteristics of bacteraemia caused by the hypermucoviscosity phenotype of Klebsiella pneumoniae in Korea. Epidemiol Infect 2012; 141:334-40. [PMID: 22578630 DOI: 10.1017/s0950268812000933] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hypermucoviscous (HV) isolates of Klebsiella pneumoniae have been linked to virulence potential in experimental infections. We examined 33 isolates of K. pneumoniae from patients with bacteraemia for the HV phenotype on agar culture, and determined their virulence potential by screening for capsular (K) serotype by polymerase chain reaction and the presence of seven virulence factor genes. Fourteen (42·4%) isolates expressed the HV phenotype and 11 of these were serotype K1 or K2; these serotypes were not identified in HV-negative isolates. The genes rmpA, rmpA2, aerobactin, wabG and allS were significantly more frequent in HV than non-HV isolates. Multilocus sequence typing identified 21 sequence types (ST), eight of which were found in HV-positive isolates and the clonal relatedness of isolates of the most frequent types (ST23 and ST11) from different hospitals was confirmed by pulsed-field gel electrophoresis. The HV phenotype was more associated with community-acquired infection with a lower frequency of fatal underlying illness, but with significantly more focal infections, notably liver abscesses. Clinicians should be aware of such clinical impacts of the HV phenotype.
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